Innovation: IV fluids for Land Cruisers – Let’s get critical

An MSF innovation project enters a critical stage...

In a medical emergency in a remote location, our teams need kit that works. Tim Hull-Bailey is part of a Médecins Sans Frontières / Doctors Without Borders (MSF) innovation team aiming to design their way out of an ongoing problem – how to provide life-saving IV fluids to patients in the back of an all-purpose 4x4 car. Their prototype looks great in the studio, but what will happen when they actually put it in front of the real experts…? Tim blogs from the first day of testing…

First day of testing…

Monday morning arrived, along with Nils the product designer we are working with on this project, after a red eye flight from Scotland. We were at L’Espace Bruno Corbé (the ECB) – MSF's training ground in Brussels.

The EBC has no running water or mains electricity, and as you can imagine, it’s a vital part of MSF’s training programme, with staff coming from all over the world to learn the skills they’ll need in conflict zones, disease outbreaks and other medical emergencies. It would be the perfect place to test out our prototype in a real MSF Land Cruiser, and with the critical eyes of real MSF field staff…

Photo shows the prototype, finally installed in the back of the MSF Land Cruiser. It has a metal spine, plastic hook and elastic strap

Prototype version 1 mounted in the Land Cruiser ready for a day of testing. Photo: Nils Aksnes / Fearsome

Before our team of testers arrived, Nils and I spent a couple of hours trying to fit more of the prototypes in one of the Land Cruisers.

Nils had brought out longer bolts and we were able to fit two prototypes in the vehicle without removing the roof brace. More learnings; longer attachment bolts and a requirement to change the shape of the prototype to match the angle of the roof.

Nils was all measurements, picture and note taking; calmly, methodically working through every angle and measurement so he could build an accurate representation of the vehicle back in the office in Glasgow.

I was a little more stressed, knowing we only had this one day to capture as much insight and feedback as possible before designing our final prototype. But there wasn’t much time to worry, because before we knew it, our first team of experts had arrived.

The nurses were here.


Expert viewpoints

Working out the best way to elicit constructive feedback from people is mainly about understanding human behaviour and creating an environment where people are free to say whatever comes into their heads.

Just giving people a scenario and a product and hoping they will automatically come up with the perfect design change isn't enough. Lots of coffee, biscuits and informal chats were employed between bumpy rides around the training ground, simulating patient transfers.

We wanted the nurses to relax, have fun, ask as many obvious or obscure questions as possible, and of course, give their honest opinion and feedback. They were fantastic; endlessly enthusiastic and extremely insightful.

Carolin and Elena from Frankfurt in the morning and Evelyn, Anne and Andrea from Brussels in the afternoon gave us a long list of things we hadn’t previously considered. Things like...

  • Get the hook height as high as possible to help the fluids flow and ensure they are easy to monitor
  • New nurses may lack training in patient transfer so a simple instruction graphic would be useful
  • Sometimes hard IV bottles are used, rather than the plastic bags we'd been designing for, so the holder should work for these also

These are just a few of their comments. I was amazed and Nils was super happy with the quality of the feedback.

Image shows an MSF nurse hanging the fluids on the prototype in a land cruiser

Carolin and Elena simulating a patient transfer testing out the prototype (Credit: Nils Aksnes, Fearsome)


The handbag problem

At lunch we were joined by a team of logisticians (or ‘logs’), who were equally enthusiastic. After a quick introduction about the project they poured over the vehicle inspecting the design.

I think the logs must have redesigned the prototype ten times in the space of forty-five minutes!!! It was encouraging to see they were asking the same questions as Josie, Anup and myself had asked earlier in the project, giving confidence that the design process had been reflective of real field staff.

Image shows a team of MSF logisticians crowded into the Land Cruiser as they examine the prototype

The logisticians redesigning the prototype and checking for handbag strength! Photo: Nils Aksnes / Fearsome

They gave us great tips on suitable materials for the holder, possible other uses of the vehicle that it might interfere with, and other things the hook might get used for (“People will definitely hang handbags on this, and you know how much stuff some people carry in a handbag!”).

Yes, we ended up taking into consideration that our beautifully designed IV fluid bag holder would suffer the ignominy of being used to hang handbags. All part of the design process said Nils, “if it’s a possibility we must design for it, every eventuality”, the hook would be metal in order to hold the heaviest of handbags!!!

Back to the Drawing Board

With our invaluable feedback collected in notebooks, stacks of feedback forms, videos, pictures and rapidly degenerating memories, it was back to “sunny” Scotland to compile the themes of the comments and insights. These would inform the final iteration of design allowing us to manufacture a batch of prototypes for real life extended field testing.

Incredibly from what appeared to be a few scraps of paper and smart phone pictures Nils and the team at Fearsome created a 3D computer model of the location point inside the land cruiser. This would form the basis for a 3D printed model so we could actually fit the next prototype to a replica of the Land Cruiser.

Image shows a computer generated drawing of the inside of the MSF Land Cruiser

Computer generated 3D model of the Land Cruiser attachment point, created from phone pics and scraps of paper. Photo: Robert Patience / Fearsome

After few more weeks of development, focussed on addressing key themes emerging from the feedback the design had been optimised, a 3D printed model was made and sent out to Delphine, the manager at EBC in Brussels to carry out a quick ‘fit test’ to make sure it would actually fit in a real Land Cruiser before we manufactured them for real.

Image shows the 3d printed prototype in the back of a Doctors Without Borders Land Cruiser

3D printed model of the Land Cruiser attachment point. Photo: Nils Aksnes / Fearsome

With the fit test a success we were ready to manufacture a small number of v2 (version 2) prototypes, incorporating all the valuable suggestions and feedback gleaned from that sunny day in Brussels in late September. The holder was now formed to the angle of the land cruiser, it was predominantly metal for strength, it had instructional graphics for ease of use and there’s a neat magnetic tab to keep the stabilisation strap out of the way when not in use.

And yes, this baby can carry the mother of all handbags!!!

A 3d printed version of the IV fluids holder, set up with the fluids in place

The 3D printed prototype with the IV fluids in place. Photo: Nils Aksnes / Fearsome

Field Project Testing

Meanwhile we had been busy finding MSF projects where there are relatively high numbers of patient transfers and that would be happy to field trial our prototype for a few months. This is not always that easy, becaise field projects are stressful places where people are often working at full capacity. They can therefore be understandably reluctant to devote extra time and resources to innovation projects.

This is where we believe projects like ours, which have had the funding to go through a rigorous prototype testing, can be different. We believe that whilst there will be some time commitment in giving feedback to the design team this will be worth it as the design should benefit staff and patients immediately.

The Pugnido project in Ethiopia and the Tonkolili project in Sierra Leone have kindly volunteered to be our guinea pigs for around three months. They are projects with relatively high numbers of patient transfers and we hope to gain invaluable insight and feedback from the project staff about how the IV holder works and where there is room for improvement.

This final round of testing is critical before we finalise our design, making sure it is truly fit for purpose, meeting the demands of the field and designed by the staff in the field.

We’re looking forward to learning so much more about our IV-holder, good, bad and curious! I’m sure more than handbags will be hung on it!

Hopefully we’ll be able to let you know how it has performed in the next few months.


Thank you

So many people have helped us reach this stage of the project, so thank you to all and in particular…

  • Delphine in the EBC for letting us modify and steal her Land Cruisers, helping with the fit test and general organisation of the test day.
  • Jean-Eric Schaeffer and his logs for their critical logistician eyes and awesome feedback.
  • Andrea, Anne, Evelyn, Carolin and Elena (the nurses) for devoting their time, bouncing about in the back of the Land Cruiser and being so enthusiastic, insightful and honest in their feedback.
  • Diane and Marlene for carrying the IV-holders to the field.
  • The Pugnido and Tonkoliliprojects for agreeing to field test the prototype.
  • Nils and all the guys at Fearsome for patiently educating yet another MSF staffer in the ways of product design.

Will the prototype stand up to life on the frontline of MSF’s work? Can it make a difference for our patients? Tim will be reporting back in his next blog post…

Want to read about how this project started? Check out the blogs from Josie and Anup, here.